AUTHOR=Han Yong-Feng , Jiang Peng , Tian Zhong-Bin , Chen Xi-Heng , Liu Jian , Wu Zhong-Xue , Gao Bu-Lang , Ren Chun-Feng 

TITLE=Risk factors for repeated recurrence of cerebral aneurysms treated with endovascular embolization

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.938333

DOI=10.3389/fneur.2022.938333

ISSN=1664-2295

ABSTRACT=Purpose: To explore the risk factors of recurrence after second endovascular embolization of recurrent aneurysms and the characteristics of recurrent refractory aneurysms to help clinical decision making. 
Materials and methods：Forty-nine patients with recurrent aneurysms who underwent repeated embolization were retrospectively enrolled and divided into the recurrent and non-recurrent group. The risk factors of recurrence, complications and follow-up results of repeated embolization and characteristics of recurrent refractory aneurysms were analyzed.
Results: Among the 49 patients with the second embolization, five were lost to follow-up, nine recurred, and 35 did not. Univariate analysis showed aneurysm size (P=0.022), aneurysm classification (P=0.014), and Raymond-Roy grade after the second embolization (P=0.001) were statistically different between the two groups. Multivariate analysis demonstrated the Raymond-Roy grade as an independent risk factor for recurrence of aneurysms after the second embolization (P = 0.042). The complication rate after second embolization was 4%. There were five recurrent refractory aneurysms with an average aneurysm size of 23.17±10.45mm, including three giant aneurysms and two large aneurysms. To achieve complete or near-complete embolization of the recurrent refractory aneurysms, multiple treatment approaches were needed with multiple stents or flow diverting devices.
Conclusion: Aneurysm occlusion status after the second embolization is an independent risk factor for recurrence of intracranial aneurysms. Compared with the near-complete occlusion, complete occlusion can significantly reduce the risk of recurrence after second embolization. In order to achieve complete or near-complete occlusion, recurrent refractory aneurysms need multiple treatment with the use of multiple stents or flow diverting devices.